RESUMEN
OBJECTIVE: To assess the accuracy of a previously undescribed method of determining tibial nail length based on anatomic landmarks. DESIGN: Cadaveric study. METHODS: Four methods of tibial nail length determination were compared. Nail lengths for each of fourteen cadaveric lower extremities were determined using full-length scanograms, spotograms, acrylic template overlays, and the distance between the tibial tubercle and the medial malleolus (TMD). Each tibia was then nailed. The accuracy of each method was then evaluated. RESULTS: The full-length scanogram method resulted in incorrect nail lengths in eleven of fourteen (79 percent) cases. Six of fourteen (43 percent) incorrect nail lengths resulted from the use of spotograms. All measurements made with the Template technique yielded nails that were too short (100 percent). The TMD method rendered four of fourteen (29 percent) nails of incorrect size. CONCLUSION: The tibial tubercle-medial distance (TMD) proved an easy, inexpensive, and accurate method of preoperative nail assessment.
Asunto(s)
Fijación Intramedular de Fracturas/instrumentación , Fracturas de la Tibia/cirugía , Adulto , Articulación del Tobillo/patología , Antropometría , Diseño de Equipo , Humanos , Articulación de la Rodilla/patología , Fracturas de la Tibia/patologíaRESUMEN
Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7 degrees (range, 4-14 degrees), the average hallux valgus angle was 11 degrees (range, 4 degrees of varus to 30 degrees of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0-5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small (r < or = 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Huesos Metatarsianos/diagnóstico por imagen , Huesos Tarsianos/diagnóstico por imagen , Adulto , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/etiología , Humanos , Inestabilidad de la Articulación/complicaciones , Inestabilidad de la Articulación/fisiopatología , Huesos Metatarsianos/fisiopatología , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Huesos Tarsianos/fisiopatología , Dedos del Pie/diagnóstico por imagen , Dedos del Pie/fisiopatología , Soporte de PesoRESUMEN
The incidence of malignant soft-tissue sarcomas in the general population is approximately 1.4 per 100,000. Approximately 2% of all cancer deaths are attributable to these tumors. Presented is a case history of a soft-tissue malignant neoplasm that was originally thought to be an interdigital neuroma and that eventually required a modified Chopart's amputation. A review of the literature is presented on other soft-tissue malignant tumors that have an affinity for the foot and ankle. The intention of presenting this case is to caution physicians that malignant lesions can simulate a benign process and should always be considered in the differential diagnosis of any foot mass.